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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Annual Hospital Interview
Modified
608
1216
0
Form and Instruction
0920-0212
Att C - Annual Hospital Interview
Annual Hospital Interview (Revised)
Removed
0
0
0
Form
0920
Annual Hospital Interview (revised)
Initial Hospital Intake Questionnaire
Modified
150
136
0
Form and Instruction
0920-0212
Att I - Initial Intake Questionnaire
National Hospital Care Survey (Abstraction Form)
Removed
0
0
0
Form
0920-0212
Validation of Enhanced Algorithms to Identify Opioid Use and Co-Occurring Disorders in National Hospital Care Survey (NHCS)
PCORFIT Telephone Script
Removed
0
0
0
Other-WORD
Prepare and Transmit EHR for Inpatient and Ambulatory
Modified
800
800
0
Form and Instruction
0920-0212
Att L - Qtr Data Trans of EHR Data
Prepare and transmit UB-04 or State File for Inpatient and Ambulatory
Modified
4896
4896
0
Form and Instruction
0920-0212
Att K - Monthly Data Transmission of UB-04 Data
Recruitment Survey Presentation
Modified
150
136
0
Form and Instruction
0920-0212
Att J - Recruitment Survey Presentation
Total burden requested under this ICR:
6604
7184
0
To view an IC, click on IC Title